本文選題：急性腎損傷　切入點：病因　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討上尿路梗阻致急性腎損傷的病因以及分析影響腎功能恢復(fù)的相關(guān)性因素,為臨床更好地預(yù)防急性腎損傷、改善患者的預(yù)后提供依據(jù)。方法:回顧性分析2012年1月至2016年12月期間在廣西醫(yī)科大學(xué)第一附屬醫(yī)院泌尿外科住院治療的患者的臨床資料,按照納入與排除標(biāo)準(zhǔn),篩選出病史完整的118例AKI患者,記錄患者基本情況、相關(guān)檢查、治療方式、預(yù)后等臨床資料。以患者術(shù)后1月作為截止點,根據(jù)AKI患者腎功能恢復(fù)情況,將AKI患者預(yù)后分為腎臟治愈組,部分愈合組及愈合不良組組三組。用SPSS16.0統(tǒng)計學(xué)軟件統(tǒng)計分析AKI患者預(yù)后的獨立危險因素。運用了χ2檢驗、獨立樣本t檢驗、單因素方差分析以及多元Logistic回歸分析統(tǒng)計分析方法。結(jié)果:觀察118例上尿路梗阻致急性腎損傷的病因中,上尿路結(jié)石是最常見的病因,占88.14%,腫瘤轉(zhuǎn)移或者壓迫,占7.63%,其他導(dǎo)致急性腎損傷占4.24%,比如輸尿管炎性狹窄、移植腎輸尿管下端狹窄并積水等。其中上尿路結(jié)石所致急性腎損傷患者的病因中,孤立腎輸尿管結(jié)石占52.88%(55/104);雙側(cè)輸尿管結(jié)石占34.62%(36/104);單側(cè)輸尿管結(jié)石合并另一側(cè)腎結(jié)石4.8%(5/104);一側(cè)輸尿管結(jié)石7.69%(8/104)。獨立樣本t檢驗分析腎功能恢復(fù)與患者年齡、血鉀濃度(K+)、血紅蛋白(Hb)等一般臨床資料無關(guān),單因素卡方檢驗分析提示術(shù)后是否出現(xiàn)多尿期、AKI分期以及RRT與腎臟預(yù)后差異有統(tǒng)計學(xué)意義,但經(jīng)多因素校正后僅臨床分期以及RRT腎臟預(yù)后差異有統(tǒng)計學(xué)意義。結(jié)論:本組資料中急性腎損傷的主要病因為上尿路結(jié)石、其次為腫瘤;AKI臨床分期為急性腎損傷患者預(yù)后不良的危險因素,RRT是上尿路梗阻性急性腎損傷的保護因素。
[Abstract]:Objective: to investigate the etiology of acute renal injury caused by upper urinary tract obstruction and to analyze the related factors affecting the recovery of renal function in order to prevent acute renal injury in clinic. Methods: the clinical data of patients hospitalized in Urology Department of the first affiliated Hospital of Guangxi Medical University from January 2012 to December 2016 were analyzed retrospectively. A total of 118 patients with AKI with complete history were selected to record the basic information, relevant examinations, treatment methods, prognosis and other clinical data. Taking January as the cut-off point, according to the recovery of renal function in patients with AKI, The prognosis of AKI patients was divided into three groups: kidney healing group, partial healing group and poor healing group. The independent risk factors of prognosis of AKI patients were statistically analyzed by SPSS16.0 statistical software. 蠂 2 test and independent sample t test were used. Results: among 118 cases of acute renal injury caused by upper urinary tract obstruction, upper urinary tract stone was the most common cause, accounting for 88.14%, tumor metastasis or compression. Other causes of acute renal injury, such as ureteral inflammatory stenosis, renal graft ureteral stenosis and hydronephrosis, were among the causes of acute renal injury caused by upper urinary calculi. Isolated renal ureterolithiasis accounted for 52.88 / 104%; bilateral ureteral calculi accounted for 34.62% 36 / 104%; unilateral ureterolithiasis combined with another side of renal calculi 4.8 / 104; side ureteral stones 7.69% / 104; independent sample t test analysis of renal function recovery and patient age. There was no significant difference in clinical data, such as serum potassium concentration and hemoglobin (HB). Univariate chi-square test showed that there were significant differences in the stage of polyuria and the prognosis between RRT and kidney. But only clinical stage and renal prognosis of RRT were significantly different after multivariate correction. Conclusion: the main cause of acute renal injury in this group is upper urinary calculi. The clinical stage of AKI was the risk factor of poor prognosis in patients with acute renal injury. RRT was the protective factor of acute renal injury caused by upper urinary tract obstruction.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692

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